Improving electrocardiogram interpretation skills for medical students

Dear editor

We read with great interest the article by Zeng at al¹ who propose a new electrocardiogram (ECG) teaching method called the “graphics-sequence memory method”. An ECG is one of the most important diagnostic tests and is currently used as a gold standard for the diagnosis of a number of cardiac diseases. We appreciate that it can be a challenging concept to teach, often bringing frustration to the educators trained in ECG interpretation. Zeng et al¹ highlight a deficiency in learning through the traditional Chinese disease-based teaching method, resulting in a relative inability to interpret ECGs where the diagnosis is not quite so straightforward. Accumulation of evidence² has suggested that a significant proportion of undergraduate medical students do not feel competent in their interpretation of an ECG. Therefore, the authors are right to suggest a novel approach with the dual benefit of aiding teaching and improving learning and confidence when interpreting an ECG.

As current medical students who have already been taught ECG interpretation, we can vouch for the complexities of an ECG trace and the challenges posed in trying to master its analysis. At our institutions, a more integrated approach is currently adopted. In addition to traditional learning using a mixture of textbooks and lectures, an approach similar to the aforementioned “graphics-sequence memory method” is being trialled to aid ECG interpretation. This novel method of teaching is one that we feel would have been extremely beneficial to our learning. Such an approach allows students to carry out a step-by-step analysis, ensuring that crucial ECG waveforms and, therefore, diagnoses are not missed.

Despite our appreciation for the article, we believe that there is still further room for improvement to the technique. Self-directed learning is an important part of the study of medicine, especially with limited teaching time and resources available. We believe that an introduction of a web-based ECG teaching module could potentially prove beneficial. Although previous studies that have developed a readily available web-based teaching module have demonstrated its effectiveness,^3,4 a sufficiently powered randomized controlled trial similar to the one implemented by Zeng et al¹ investigating outcomes following web-based ECG teaching is required to confirm this hypothesis.

At Imperial College London, a combination of e-modules alongside traditional learning methods is applied in an effort to familiarize students with common cardiac pathologies. Furthermore, the continuous availability of these resources throughout the year has been shown to be especially beneficial. A recent case–control study by Chudgar et al⁵ assessing the efficacy of an ECG teaching module demonstrated a significant increase in confidence and improved ability to interpret an ECG by students, in comparison to those who did not have access to the module. This suggests that an integrated step-by-step approach to ECG teaching is more effective than any single methodology.

In conclusion, we recommend implementation of the novel teaching technique described by Zeng et al.¹ It is hoped that this will result in a more thorough ECG approach and, therefore, improved interpretation by students. The addition of web-based teaching modules could potentially be used as a learning aid.